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Brandt’s Rants: New Zealand is deliciously different : Emergency Medicine News

International EM, rural EM, humor:

Orf causes scab-like lesions, left, and raised fluid-filled vesicular lesions.


Working in a rural New Zealand hospital for six months was remarkably similar to working in a major American city. Oops, wait. My computer crashed for a second. Just go back and change the words ‘remarkably similar’ to ‘breathtakingly, incredibly and deliciously different’. Ah, now that’s closer to the truth.

Here in good old Gisborne, we are several hours from the nearest major trauma center. We’re several hours away from just about anything but fantastic surf and lots of friendly sheep, so we have to evacuate anyone seriously ill. Unless, of course, it’s too rainy or too windy or for one of the many reasons patients can’t fly. Then, of course, it’s up to us to take care of them.

I admit that I miss having specialists. We don’t have cardiology. Also, we don’t have neurology. And no resuscitators, interventional radiology, nephrology, pulmonology, urology, and most other specialists. We have an ENT and two ophthalmologists so we have that to ourselves which is good.

Physicians working in rural emergency departments across the United States (and the world) are the truest BAFERDs of our specialty in my humble opinion. Rural communities are often older, sicker and have less access than our urban cohorts. My respect for those who work in these difficult fields has only grown since I started my career here.

I’m lucky; I still have an abundance of resources that many don’t. But the interesting stories and unique cases that show up in a small, rural emergency department can be staggering. In addition, being separated forces a certain autonomy and close relationships with the specialists I have. Our surgeons also function as gastrointestinal, urologist, and vascular physicians, and knowing what can and cannot be done requires open communication and cooperation.

I felt exhausted in the United States, and my experiences here rekindled my love for medicine. All that aside, the work is remarkably similar. Oops, there is still this bug.


Of course, it’s the same thing. We see an abundance of chest pain, abdominal pain, and malaise in 92-year-olds. On the other hand, I haven’t seen an angry drunk patient in six months, opioids are rarely prescribed and all prescriptions cost five bucks. But working in a new country also presented illnesses that I had never seen before.

I recently took care of a sweet boy with a skin rash. His mom wanted to know if it was measles (many are not vaccinated in our community). It sometimes feels like every virus outbreak on the planet has to happen to the ER. But this little guy had weird spots on his arm that just wouldn’t go away after a few weeks. Uh, that sounds weird. You guessed it, sporotrichosis. Honestly, usually not at the top of my differential for rashes. But here, just another patient. Yes, this case could have presented itself in any American emergency department, but zebras seem to appear here commonly. I hadn’t heard of my next case before moving to New Zealand, but almost every emergency doctor here had seen several cases.

My next patient had orf.

You know, phew!

Good old orf.

What is orf?

It sounds like something a sick seal might say when asked how it feels. “How do you feel, Mr. Seal?”

“I feel a bit gold. ORF! ORF!”

If you knew orf, congratulations, but for the rest of us, orf is a poxvirus that causes large scabby lesions wherever virus-laden wool has touched. It looks like an abscess, but never break it. I learned to let the orf take its course. You see it in people working with sheep, which is remarkably common here. Fun fact: New Zealand has more than five sheep for every person.

Palm thorns?

Then there was the phoenix palm. I had never heard of this plant. The fronds like to go into the skin but don’t come out. My patient had weeded and accidentally got stuck at the base of his finger. Her swollen finger seemed quite sore, and I suspected early flexor tenosynovitis. I know some American hand surgeons would yell at me for calling without even trying to get him out, but I called the orthopedic surgeon anyway. The call looked like this:

Me: Hi. I have a patient who hit his hand on the palm of a phoenix. I’m worried about….

Orthopedic Surgeon: Oh, those plants are real bastards. No problem, we admit, and he will have to go to the theater to wash up.

Me: (gurgles surprised at how easily it went) Um, thank you.

Ortho: Well done.

What’s great about small rural SUs is the people. We all know that our resources are limited and that we are in the same boat. The camaraderie is fantastic and the dedication to helping our community is uplifting. The experiences so far have been instructive, encouraging and rejuvenating for me as a physician. Each location has its unique quirks and challenges, but if I had to choose to do it again, I’d jump at the chance. Cheers!

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Dr Brandtis an emergency physician currently working in New Zealand (after 12 years in Michigan). Read his blog and other articles on, follow him on Twitter@brandtwriting, and listen to his ED comedy podcast, “EpineFriends,” which can be found on read his past REM columns to